Comparative Study of Combination of Oral Tranexamic Acid With Modified Kligman's Formula Versus Oral Tranexamic Acid With Azelaic Acid 15% in the Treatment of Melasma.

Background Melasma is a persistent skin condition affecting individuals of Asian, African, and Hispanic backgrounds. It causes dark patches on sun-exposed areas of the face. The exact causes are unclear, but UV light and hormonal factors play a role. Melasma significantly impacts physical appearance and quality of life, causing emotional and social distress. Objective The objective was to compare the efficacy of a combination of oral tranexamic acid and modified Kligman's formula vs. oral tranexamic acid and 15% azelaic acid. Material and methods This two-year interventional study occurred at the Outpatient Department of Dermatology, Venereology, and Leprosy in Sawangi, Maharashtra. It included male and female patients aged 18-50 with melasma seeking treatment. Ethical approval was obtained, and data collection involved medical histories, skin examinations, and calculating the Melasma Area and Severity Index (MASI). Results The study found no significant association between age groups and subject distribution in Groups A and B. Significant differences were observed in MASI scores within each group over time. There was a significant difference in mean MASI scores between Group A and Group B at the eight-week mark. A burning sensation was significantly associated with the groups, while no significant association was found for erythema. Conclusion This study concludes that combining oral tranexamic acid with a modified Kligman's formula is more effective in treating melasma than combining oral tranexamic acid with azelaic acid 15%.

Actinic Lichen Planus: Significance of Dermoscopic Assessment.

Actinic lichen planus (LP) is a rare variant of the already infrequent LP. LP is a chronic inflammatory skin disorder seen in 1-2% population of the world. The classical presentation is in the form of the four P's namely pruritic, purplish, polygonal, papules and plaques. On the contrary in this variant of actinic LP, although the lesions look similar in appearance they are characteristically distributed over the photo-exposed areas of the body like the face, extensors of the upper limbs, and dorsum of hands. Koebner's phenomenon which is characteristic of LP is absent. The commonest differentials that leave the clinician in a fix are usually discoid lupus erythematosus, granuloma annulare, and polymorphous light eruptions. A detailed clinical history followed by histopathological examination aids in the final diagnosis in such cases. In scenarios where the patient is not willing for a minor interventional procedure such as a punch biopsy, dermoscopic assessment comes to the rescue. Dermoscopy being an inexpensive, non-invasive, and minimal time-consuming procedure helps in the early diagnosis of a wide range of cutaneous disorders. Fine, reticulate white streaks over the surface of papules or plaques of LP known as "Wickham's striae" act as the diagnosis clincher for most cases of LP. The numerous variants of LP have consistent biopsy findings and the mainstay for treatment remains topical or systemic corticosteroids. We report this case of a 50-year-old female farmer that presented with multiple violaceous plaques on photo-exposed areas of the body owing to its rarity and use of dermoscopy in enabling a prompt diagnosis that helped improve the patient's quality of life.

A curious case of upper limb infection.

We report a case of chronic upper limb infection in an immunocompetent male. The condition started after penetrating trauma with a wooden splinter while working on a farm. The Microbiological study helped in the confirmation of the diagnosis of Botryomycosis. The patient was treated with a prolonged course of parenteral antibiotics.